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David Weismiller, MD, Scm, FAAFP 8:30 Board Review Express® February 6-9, 2020 Virtual Course geor Day 1 Thursday, February 6 8:00 – 8:30 am Welcome & Overview – David Weismiller, MD, ScM, FAAFP 8:30 – 9:15 am Health Promotion & Prevention – David Weismiller, MD, ScM, FAAFP 9:15 – 9:45 am Common Issues in the Elderly I – Russell Blackwelder, MD, MDiv, CMD 9:45 – 10:15 am Common Issues in the Elderly II – Russell Blackwelder, MD, MDiv, CMD 10:15 – 10:30 am Q&A 10:30 – 10:45 am Break 10:45 – 11:15 am Acute & Chronic Cognitive Diseases – Russell Blackwelder, MD, MDiv, CMD 11:15 – 11:45 pm Obesity & Metabolic Syndrome – Belinda Vail, MD, FAAFP 11:45 – 12:15 pm Unique Geriatric Pharmacologic Issues – Russell Blackwelder, MD, MDiv, CMD 12:15 – 12:30 pm Q&A 12:30 – 1:30 pm Break 1:30 – 2:00 pm Diabetes – Belinda Vail, MD, FAAFP 2:00 – 2:30 pm Common Newborn Issues– Janalynn Beste, MD, FAAFP 2:30 – 3:00 pm Preoperative Examination & Surgical Management – Belinda Vail, MD, FAAFP 3:00 – 3:15 pm Q&A 3:15 – 3:30 pm Break 3:30 – 4:00 pm Well-Child Care & Adolescent Issues – Janalynn Beste, MD, FAAFP 4:00 – 4:30 pm Abnormal Uterine Bleeding – David Weismiller, MD, ScM, FAAFP 4:30 – 5:00 pm Fever & Infectious Diseases in Children – Janalynn Beste, MD, FAAFP 5:00 – 5:15 pm Q&A 5:15 – 6:00 pm Guide to Exam Preparation (no CME) – David Weismiller, MD, ScM, FAAFP 2020 Board Review Express® Course Chair David Glenn Weismiller, MD, ScM, FAAFP Professor Department of Family and Community Medicine University of Nevada, Las Vegas School of Medicine [email protected] Course Objectives • Discuss common clinical problems in family medicine. • Summarize an evidence-based approach to current advances in the diagnosis and treatment of common clinical problems. • Demonstrate successful study and test-taking techniques. Course Information Page •Board Review Express Course Page − Course Schedule − Course Syllabus − Audience Engagement System (AES) − Board Review Self-Study Package Other Housekeeping • Badge • Write your name in your syllabus • Silence Cell Phones • Issues/Concerns/Information − Material/Exam – Faculty − Course – AAFP Staff • SORT • Levels of Evidence • USPSTF GUIDANCE WITH NOMENCLATURE SORT Strength of Recommendation Taxonomy • Category A: Recommendation based on consistent and good-quality patient-oriented evidence. • Category B: Recommendation based on inconsistent or limited quality patient-oriented evidence. • Category C: Recommendation based on consensus, usual practice, opinion, disease-oriented evidence-based series for studies of diagnosis, treatment, prevention, or screening Levels of Evidence Meta Analysis of RCT A statistical analysis that combines or integrates the results of several independent clinical trials considered by the A analyst to be "combinable" usually to the level of re-analyzing the original data, also sometimes called: pooling, quantitative synthesis. Systematic Review of Review of a body of data that uses explicit methods to locate primary studies, and explicit criteria to assess their RCT quality. High quality RCT Individuals are randomly allocated to a control group and a group who receive a specific intervention. Otherwise the two groups are identical for any significant variables. They are followed up for specific end points. Sensitivity and True positive rates and true negative rates for diagnostic tests. specificity (test) Cohort study Groups of people are selected on the basis of their exposure to a particular agent and followed up for specific B outcomes. Case control study "Cases" with the condition is matched with "controls", and a retrospective analysis used to look for differences B between the two groups. B Cross sectional study Survey or interview of a sample of the population of interest at one point in time Case report or case A report based on a single patient or subject; sometimes collected together into a short series. series C Expert opinion A consensus of experience from the good and the great C Anecdote A conversation Definitions of USPSTF Recommendation Grades Grade Definition Suggestion for practice The USPSTF recommends the service; there is high certainty that the net Offer/provide this service A benefit (i.e., benefits minus harms) is substantial The USPSTF recommends the service; there is high certainty that the net Offer/provide service B benefit is moderate or there is moderate certainty that the benefit is moderate to substantial The USPSTF recommends against routinely providing the service; there may Offer/provide the service only if be considerations that support providing the service in an individual patient; there are other considerations in C there is moderate or high certainty that the service has no net benefit or that support of offering/providing the the harms outweigh the benefits service in an individual patient The USPSTF recommends against the service; there is moderate or high Discourage the use of this service D certainty that the service has no benefit or that the harms outweigh the benefits The USPSTF concludes that the current evidence is insufficient to assess the If offered, patients should balance of benefits and harms of the service; evidence is lacking, of poor understand the uncertainty about I quality, or conflicting, and the balance of benefits and harms cannot be the balance of benefits determined and harms Schedule • Conclude at 6:00 PM CST today • Break • 12:45-1:45 PM CST • Lectures • Thursday – Saturday - 8:00 AM CST • Sunday – 7:30 AM CST Audience Engagement System https://aafp4.cnf.io/ 1. Which former president was born in Missouri? A. Woodrow Wilson B. Harry S. Truman C.Theodore Roosevelt D.Dwight D. Eisenhower 2. Which performing arts legend created the role of Dolly Levi on Broadway? A. Barbra Streisand B. Elaine Stritch C.Angela Lansbury D.Carol Channing 3. In what year did The University of Oregon defeat The Ohio State University to win the first-ever NCAA men’s basketball tournament? A. 1939 B. 1941 C. 1946 D. 1952 4. When do you plan on taking your board examination? A. April 2020 B. November 2020 C. April 2021 D. Taking the FMCLA E. Not taking boards, here for CME only © 2020 American Academy of Family Physicians. All rights reserved. All materials/content herein are protected by copyright and are for the sole, personal use of the user. No part of the materials/content may be copied, duplicated, distributed or retransmitted in any form or medium without the prior permission of the applicable copyright owner. Health Promotion and Prevention David Glenn Weismiller, MD, ScM, FAAFP Department of Family and Community Medicine University of Nevada, Las Vegas School of Medicine Disclosure Statement It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest. If conflicts are identified, they are resolved prior to confirmation of participation. Only participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity. All individuals in a position to control content for this session have indicated they have no relevant financial relationships to disclose. Learning Objectives 1. Describe the differences between health promotion, prevention, and screening. 2. Recognize the three leading causes of morbidity in the United States. 3. Counsel patients on necessary lifestyle modifications to maintain health. 4. Reinforce the necessity of patient education and counseling for health promotion, including healthy diets, exercise, and smoking cessation. Health Promotion and Prevention •Effective health promotion −Lifestyle modification: 3 leading causes of morbidity in the US −Counseling •Prevention −Primary e.g., Immunizations −Secondary e.g., Breast cancer • Screening – done in asymptomatic patients −Tertiary e.g., Heart Failure Reduced Ejection Fraction (HFrEF) −Quaternary • Set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the health system. It is the practice of “first do no harm.” Examples of Quaternary Prevention • Avoiding the indiscriminate use of antibiotics • Aspirin for the primary prevention of stroke in men • Mistaking a risk factor for disease • Avoiding unnecessary exams ▪ e.g. stool Hemoccult after normal colonoscopy • Avoiding unnecessary screening • e.g. Pap tests after the age of 65 Who is involved? 2020 •AAFP and more than 80+ partners comprising over one million clinicians are now partners of the Choosing Wisely campaign •Specific, evidence-based recommendations clinicians and patients should discuss > 550 recommendations Choosing Wisely® is an initiative of the ABIM Foundation. http://www.choosingwisely.org Lists •Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation. •In collaboration with the partner organizations, Consumer Reports has created resources for consumers and providers to engage in these important conversations about the overuse of medical tests and procedures that provide little benefit and in some cases harm. Choosing Wisely® is an initiative of the ABIM Foundation. http://www.choosingwisely.org Best Practice Recommendations • The Choosing Wisely initiative addresses overuse of tests and treatments in medical care • Goal: Informed decision making that leads to intelligent and effective patient care choices • Targeted interventions are needed
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